Healthcare Provider Details

I. General information

NPI: 1205450830
Provider Name (Legal Business Name): RAVNEET SANDHU DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37569 HIGHWAY 26
SANDY OR
97055-9301
US

IV. Provider business mailing address

131 TEAL LN
ROSEBURG OR
97471-7846
US

V. Phone/Fax

Practice location:
  • Phone: 503-668-5210
  • Fax:
Mailing address:
  • Phone: 541-670-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDP221847
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: